“The hazard of the operation, and the little chance he had of its proving successful, being explained to him, the unfortunate man earnestly begged to be relieved from so hideous a load, even though he should die under the operation. I therefore yielded to his entreaties, and took off the hand a little above the wrist, in November 1782, although there was a small indurated gland above the elbow. On dissecting the hand immediately after I had taken it off, the fungus, on being cut, appeared to be extremely similar to the substance of the brain, and to arise from the metacarpal bones of the middle and fore-finger. These bones were in part dissolved, and the other bones of the hand were also in a morbid state.
“No accident occurred during the amputation; but soon after it, a colliquative diarrhœa came on, which seemed to be increased by opiates and astringents, but was at length checked with draughts of fixed alkaline salt and lemon juice, swallowed in the act of effervescence. He afterwards took the bark, drank seltzer water, and was allowed a liberal use of wine. The suppuration for some time was ichorous and bad, but he gained strength daily. At the end of seven weeks, the stump was completely cicatrized, and the indurated gland above the elbow had disappeared. He went into the country, drank goat’s whey, bathed in the sea, became very corpulent, and seemed to be in perfect health, but had somewhat of a sallow bloated appearance. He continued well till July 1783, when he began to complain of pains in his back, attended with rigidity. These pains, as they increased, extended down his thighs and legs, and occasioned him to sleep ill at night. He grew feverish, his pulse beat extremely quick, and his countenance acquired a shining yellowish red colour, an appearance which I have remarked to be characteristic of a cancerous habit. He now began to walk with difficulty. I took a small quantity of blood from him, and found the texture of the crassamentum extremely loose, and the serum in too great quantity. He was very difficult to purge, and unfortunately was under a constant necessity of taking medicines to procure the necessary discharges. Antimonials in a variety of forms were given, and the bark was again tried, as were all the medicines that are usually prescribed in rheumatic cases. Blisters were applied, and issues cut in his thighs, but all to no purpose. He was obliged to take to his bed in August, and never after quitted it.
“It is difficult to form an idea of the constant and excruciating pain this poor man suffered. Opium, though given in large doses, afforded him but little relief, and at last none at all. He generally lay on his back, fixed as it were to the bed, the least motion occasioning the most intense pain. As the disease advanced, he complained of a difficulty of passing his urine, which was loaded with a viscid mucus, and he once discharged an oblong calculus; but at last he voided his urine involuntarily, and sometimes even his fœces, but the latter only rarely, when he had taken a purgative, which, as I have already mentioned, was required to be of the most active kind, otherwise it produced no effect.
“During the whole course of the disease, his pulse was rapid, but his tongue was remarkably soft and florid. He was never delirious. Latterly, he spit blood once or twice; his lower extremities became very œdematous, and his back was covered with eschars; but these dropped off, and the sores suppurated and healed kindly. Two months before his death, his pains abated considerably. He died without pain, March 4 1784, which was about two years and nine months from the time the seton was passed, and a year and four months from the time he underwent the amputation.
“His body was opened a few hours after his death. The abdominal viscera appeared to be perfectly sound, and of their natural colour, except the liver, which had a small steatoma on its convex surface, but was in other respects healthy. The gall bladder was rather fuller of yellow bile than it is generally found to be. The left kidney was enlarged, and on dividing it longitudinally, much red gravel was found in its pelvis, and the ureter seemed much lessened. The urinary bladder was contracted, and its coats uncommonly thickened, but no sabulous concretions were observed in it.
“On each side of the vertebræ lumborum, the lumbar regions were rendered convex by a large cancerous deposition, which elevated the psoæ muscles; and when the cellular investitures, which were condensed into a cyst, were opened, the cancerous matter appeared in a large quantity, in colour and consistence exactly resembling the fungus of the hand, and not unlike the substance of the brain. The whole weighed about five pounds; and when this was removed, the last vertebra of the back, and the three first of the loins, were found to be in a softened, eroded, and in some parts a totally dissolved state. There appeared not the least mark of ichor, sanies, inflammation, or hardness of the soft parts; nor were the mesenteric glands at all affected. The matter seemed to have been really a cancerous exudation, and to be formed chiefly of coagulable lymph. This cancerous mass seemed to possess a remarkable dissolving power, which was exerted wholly on the bones, and did not, as usual in cases of this sort, cause any schirrous hardness of the surrounding soft parts.”
CASE V.
A woman, some time after receiving a blow on the leg, perceived a small moveable tumor. It was soft, elastic, and seated on the outside of the leg, about half way betwixt the knee and ankle joint. I made a small incision through the skin down to the tumor, and dissected it off to its base. I then dissected the substance off from the facia of the muscle, and brought the skin together with adhesive plaster. It united readily, and the patient was cured. The tumor was soft, like brain, of a greyish colour, and greasy consistence.